- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05919940
Improved Muscle Metabolism by Combination of Muscle Activation and Protein Substitution ( IMEMPRO )
Improved Muscle Metabolism by Combination of Muscle Activation and Protein Substitution: a Randomized, Outcome-assessor Blinded, Proof-of-concept Study (IMEMPRO)
Intensive Care Unit Acquired Weakness (ICUAW) describes muscle weakness that occurs in around 40% of patients during an intensive care stay. The morbidity and mortality of these patients is significantly increased over a 5-year period. The aim of this study is to investigate the combined effect of early enteral high-protein nutrition and early muscle activation on muscle atrophy in critically ill patients.
The study will include 40 patients (20 intervention, 20 observation) with requirement for enteral nutrition at time of inclusion. In the intervention group the maximum possible level of mobilization is carried out and muscles are activated twice a day using neuromuscular electrical stimulation (NMES). The nutrition plan of the intervention group is based on the applicable guidelines for intensive care medicine with exception of increased protein intake. The control group receives therapy without deviating from the standard according of the DGEM guideline.
The study aims to show that the decrease in muscle mass is significantly less than in the control group (primary hypothesis) via ultrasound of the rectus femoris muscle and in case of given consent muscle biopsy. As secondary hypothesis it is examined whether the combination of early high protein intake and muscle activation improves muscle strength and endurance.
Study Overview
Status
Conditions
Detailed Description
Intensive Care Unit Acquired Weakness (ICUAW) describes the clinically diagnosed manifestation of a neuromuscular organ dysfunction. It develops in approximately 40% of all intensive care unit patients amounting to at least 1.2 million patients annually in Germany. All these patients face a broad range of sequeleae and an increased mortality up to 5 years after ICU discharge. A characteristic pathophysiological phenomenon is an early severe muscle atrophy reaching 10% during the first days after ICU admission.
The current preventative and therapeutic approach for ICUAW is a combination of targeted risk factor management as well as early activation of muscles, i.e. neuromuscular electrical stimulation (NMES) and early mobilization as they have been shown to counteract the muscle atrophy and mediate different outcome benefits such as shorter ICU stay.
Nutrition is a key element of our daily life. Protein intake has been shown to affect lean mass and muscle mass. Research into specific nutritional strategies to treat or prevent ICUAW are scarce and the combination with early muscle activation has not been adequately explored.
The study will include 40 patients (20 intervention, 20 observation) who were admitted to an intensive care unit within the last 48 hours. A basic requirement for inclusion is an indication for enteral (via the gastrointestinal tract) nutrition at time of inclusion. In the intervention group, the ability to mobilize is assessed daily and the maximum possible level of mobilization is carried out and additional muscles are activated twice a day using neuromuscular electrical stimulation (NMES). The nutrition plan of the intervention group is based on the applicable guidelines for intensive care medicine. In this study, protein intake is increased in the interventional group. The control group receives therapy without deviating from the standard according to the SOP and DGEM guideline: "Clinical nutrition in intensive care medicine" 2018.
The study aims to show that the decrease in muscle mass is significantly less than in the control group (primary hypothesis) via ultrasound of the rectus femoris muscle and muscle biopsy. As a second hypothesis it is examined whether the combination of early high protein intake and muscle activation improves muscle strength and endurance compared to the control group.
Further exploratory analyses will investigate changes in the skeletal muscle glycogen content, skeletal muscle histology, skeletal muscle gene expression, skeletal muscle protein level, as well as metabolomic changes in blood and urine.
An additional blood sample will be taken after 90 days as part of a follow-up.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Stefan J Schaller, MD
- Phone Number: +498941409635
- Email: s.schaller@tum.de
Study Contact Backup
- Name: Kristina Fuest, MD
- Email: kristina.fuest@tum.de
Study Locations
-
-
-
Berlin, Germany, 10117
- Recruiting
- Charité - Universitätsmedizin Berlin
-
Contact:
- Stefan J Schaller, MD
- Phone Number: +49-30-450-531052
- Email: stefan.schaller@charite.de
-
-
Bavaria
-
Munich, Bavaria, Germany, 81675
- Recruiting
- Klinikum rechts der Isar, School of Medicine, Technical Universtity of Munich
-
Contact:
- Kristina Fuest, MD
- Email: kristina.fuest@tum.de
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- critically ill adults (≥ 18 years of age)
- newly admitted to the ICU (<48h)
- mechanically ventilated, expected to remain for at least 72h
- enteral nutrition is feasible
Exclusion Criteria:
- a BMI > 30
- expected death or withdrawal of life-sustaining treatments
- prior neuromuscular disease (e.g. paresis, myopathies, neuropathies)
- injury or disease preventing neuromuscular electrical stimulation or early mobilization (e.g., elevated intracranial pressure, unstable spine)
- a pacemaker or other electronic implant
- allergy to components of NMES adhesive
- have been dependent during activities of daily living prior to the hospital admission
- a language barrier
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention
High protein substitution plus NMES and EM
|
Day one (admission) no nutrition is applied. Protein target is increased as follows:
Additional protein is given within 2 hours after mobilization respectively:
twice daily 60 minutes till day 28 or ICU discharge
at least 20 minutes a day following the SOMS concept.
Duration: till 28 day or ICU discharge
|
No Intervention: Control Group
Nutrition and mobilization are carried out according to standard of care.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in cross sectional area (ΔCSA) of the rectus femoris
Time Frame: day 1 (study inclusion) and 14 days
|
Change in muscle mass between study inclusion and study day 14; measured as change of the cross sectional area (ΔCSA) of the rectus femoris muscle via ultrasound.
|
day 1 (study inclusion) and 14 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
change in muscle thickness of the rectus femoris
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change in muscle thickness from study inclusion until 90-day follow-up, measured via ultrasound.
|
day 1 (study inclusion) until 90-day Follow-up
|
change in echogenicity of the rectus femoris
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change in echogenicity from study inclusion until 90-day follow-up, measured via ultrasound.
|
day 1 (study inclusion) until 90-day Follow-up
|
change of the pennation angle of the rectus femoris
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change of the pennation angle from study inclusion until 90-day follow-up, measured via ultrasound.
|
day 1 (study inclusion) until 90-day Follow-up
|
change of the muscle strength, measured by the Medical Research Council score (MRC-score)
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change of the muscle strength, measured by the Medical Research Council score (MRC-score) from study inclusion until 90-day follow-up
|
day 1 (study inclusion) until 90-day Follow-up
|
change of the muscle strength, measured by handgrip dynamometry
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change of the muscle strength, measured by handgrip dynamometry from study inclusion until 90-day follow-up
|
day 1 (study inclusion) until 90-day Follow-up
|
change in muscle endurance
Time Frame: up to 90 day follow up
|
change in muscle endurance, measured by the 6-minute walking test up to 90-day follow-up
|
up to 90 day follow up
|
change in physical physical function
Time Frame: up to 90-day follow-up
|
change in physical physical function, measured by the Short Physical Performance Battery up to 90-day follow-up
|
up to 90-day follow-up
|
development of quality of life
Time Frame: up to 90-day follow-up
|
development of quality of life, measured by the Short Form-36 up to 90-day follow-up
|
up to 90-day follow-up
|
change in Skeletal muscle mass
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change in Skeletal muscle mass, measured with bioelectrical impedance analysis up to 90-day follow-up.
|
day 1 (study inclusion) until 90-day Follow-up
|
change in extracellular volume
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change in extracellular volume, measured by the Body impedance analysis
|
day 1 (study inclusion) until 90-day Follow-up
|
change in the REE (Resting Energy Expenditure)
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
change in the REE (Resting Energy Expenditure), measured by indirect calorimetry
|
day 1 (study inclusion) until 90-day Follow-up
|
urea-to-creatinine ratio
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
urea-to-creatinine ratio from blood sample
|
day 1 (study inclusion) until 90-day Follow-up
|
Identify possible predictors of muscle wasting in urine metabolomics at ICU admission
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
Among the urine metabolomics that will be measured, identify metabolites or combinations of metabolites whose high or low concentration(s) at ICU admission associate(s) with the amount of muscle loss.
These metabolites are candidate biomarkers that could be used to identify individuals at risk of large muscle wasting and may give further insights into the mechanisms of muscle wasting.
|
day 1 (study inclusion) until 90-day Follow-up
|
Identify possible predictors of muscle wasting in the blood metabolome at ICU admission
Time Frame: day 1 (study inclusion) until 90-day Follow-up
|
Among the blood metabolome that will be measured, identify metabolites or combinations of metabolites whose high or low concentration(s) at ICU admission associate(s) with the amount of muscle loss.
These metabolites are candidate biomarkers that could be used to identify individuals at risk of large muscle wasting and may give further insights into the mechanisms of muscle wasting.
|
day 1 (study inclusion) until 90-day Follow-up
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
in-hospital mortality
Time Frame: until 90-day Follow-up
|
Mortality during the Hospital stay
|
until 90-day Follow-up
|
Hospital LOS
Time Frame: until 90-day Follow-up
|
Length of stay in the hospital
|
until 90-day Follow-up
|
ICU-LOS
Time Frame: until 90-day Follow-up
|
Length of stay in the ICU
|
until 90-day Follow-up
|
Hospital mortality
Time Frame: until 90-day Follow-up
|
Mortality during Hospital stay
|
until 90-day Follow-up
|
Duration of Mechanical ventilation
Time Frame: until 90-day Follow-up
|
Duration of invasive mechanical ventilator dependency
|
until 90-day Follow-up
|
ICU mortality
Time Frame: until 90-day Follow-up
|
Mortality during ICU stay
|
until 90-day Follow-up
|
enzyme function in the rectus femoris
Time Frame: according to biopsy inbetween day 1-7
|
Spectrophotometry will be done in muscle samples.
All samples will be screened for influence of Intensive Care Unit Acquired Weakness (ICUAW) and correlation with blood metabolome changes.
|
according to biopsy inbetween day 1-7
|
protein content in the rectus femoris
Time Frame: according to biopsy inbetween day 1-7
|
Western Blot will be done in muscle samples.
All samples will be screened for influence of Intensive Care Unit Acquired Weakness (ICUAW) and correlation with blood metabolome changes.
|
according to biopsy inbetween day 1-7
|
geneexpression in the rectus femoris
Time Frame: according to biopsy inbetween day 1-7
|
qPCR (quantitive polymerase chain reaction) will be done in muscle samples.
All samples will be screened for influence of Intensive Care Unit Acquired Weakness (ICUAW) and correlation with blood metabolome changes.
|
according to biopsy inbetween day 1-7
|
Muscle morphology of the rectus femoris
Time Frame: according to biopsy inbetween day 1-7
|
Light-and Electron-Microscopy will be done in muscle samples.
All samples will be screened for influence of Intensive Care Unit Acquired Weakness (ICUAW) and correlation with blood metabolome changes.
|
according to biopsy inbetween day 1-7
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Stefan J Schaller, MD, TUM, Germany & Charité - Universitätsmedizin Berlin
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IMEMPRO
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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